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Pregnancy- Induced Hypertension (PIH; preeclampsia and eclampsia)




Description
  1. Preeclampsia is a hypertensive disorder of pregnancy developing after 20 weeks’ gestation and characterized by edema, hypertension, and proteinuria.
  2. Eclampsia is an extension of preeclampsia and is characterized by the client experiencing seizures.

Etiology
  1. The cause of preeclampsia is unknown.
  2. Possible contributing factors include:
  • Genetic or immunologic
  • Primigravid status
  • Conditions that create excess trophoblastic tissue, such as multiple gestation, diabetes, or hydatidiform mole.
  • Age younger than 18 or older than 35 years.

Pathophysiology
  • Preeclampsia is a multisystem, vasospatic disease process characterized by hemoconcentration, hypertension, and proteinuria.

Assessment Findings
  1. Clinical manifestations of mild preeclampsia
    • Blood pressure exceeding 140/90 mmHg; or increase above baseline of 30 mm Hg in systolic pressure or 15 mmHg in diastolic pressure on two readings taken 6 hours apart.
    • Generalized edema in the face, hands, and ankles (a classic sign)
    • Weight gain of about 1.5 kg (3.3 lb) per month in the second trimester or more than 1.3 to 2.3 kg (3 to 5 lb) per week in the third trimester
    • Proteinuria 1+ to 2+, or 300 mg/dL, in a 24 hour sample
  2. Warning signs of worsening preeclampsia
    • Rapid rise in blood pressure
    • Rapid weight gain
    • Generalized edema
    • Increased proteinuria
    • Epigastric pain, marked hyperreflexia, and severe headache, which usually precede convulsions in eclampsia
    • Visual disturbances
    • Oliguria (<120 mL in 4 hours)
    • Irritability
    • Severe nausea and vomiting
  3. Clinical manifestations of severe preeclampsia
    • Blood pressure exceeding 160/110 mm Hg noted on two readings taken 6 hours apart with the client on bed rest.
    • Proteinuria exceeding 5 g/24 hours
    • Oliguria (less than 400 mL/24 hours)
    • Headache
    • Blurred vision, spots before eyes, and retinal edema
    • Pitting edema of the sacrum, face, and upper extremities
    • Dyspnea
    • Epigastric pain
    • Nausea and vomiting
    • Hyperreflexia
  4. Eclampsia exists once the patient has experienced a grand mal seizure. The patient may progress o more serious complications such as cerebral hemorrhage, liver rupture, and coma.
  5. Laboratory and diagnostic study findings. Abdominal test results are provided in Table.
 TEST  FINDINGS
 Blood
Hematocrit
 >40%
 Renal Function
Serum uric acid
 >5.5 mg/dL
 >6.0 mg/dL (severe     pregnancy-induced     hypertension (PIH)
 Creatinine  >1.0 mg/dL
 2.0-3.0 mg/dL (severe PIH)
 Creatinine clearance  <150 mL/min
 BUN  8-10 mg/dL
 10-16 mg/dL (severe PIH)
 Coagulation
Platelets
Fibrin degradation products
 <100,000 mL (severe PIH)
 >16 mg/mL (severe PIH)


Nursing Management

1. Monitor for, and promote the resolution of, complications.
  • Monitor vital signs and FHR.
  • Minimize external stimuli; promote rest and relaxation.
  • Measure and record urine output, protein level, and specific gravity.
  • Assess for edema of face, arms, hands, legs, ankles, and feet. Also assess for pulmonary edema.
  • Weigh the client daily.
  • Assess deep tendon reflexes every 4 hours.
  • Assess for placental separation, headache and visual disturbance, epigastric pain, and altered level of consciousness.
2. Provide treatment as prescribed.
  • Mild preeclampsia treatment consists of bed rest in left lateral recumbent position, balanced diet with moderate to high protein and low to moderate sodium, and administration of magnesium sulfate.
  • Severe preeclampsia treatment consist of complete bed rest, balanced diet with high protein and low to moderate sodium, administration of sulfate, fluid and electrolyte replacements, and sedative antihypertensives, such as diazepam or Phenobarbital, or an anticonvulsant such as phenytoin.
  • Eclampsia treatment consists of administration of magnesium sulfate intravenously.
3. Institute seizure precautions. Seizures may occur up to 72 hours after delivery.

4. Address emotional and psychosocial needs.







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